The objective of this project is to improve the evaluation, management and health outcomes of patients with biliary tract disease. The specific aims are: to determine the rates of use, variation in rates of use and health outcomes associated with alternative diagnostic tests and therapeutic modalities; to identify appropriate indications for the use of alternative tests and treatments and optimal management strategies; to use this information to help practicing physicians improve their practice patterns and the health outcomes of their patients; to assess the impact of the interventions on physician practice and health outcomes; and to demonstrate the feasibility of strategies involving physicians in developing and implementing effective intervention programs. The project also will contribute to our understanding and use of health services research methodologies, including the usefulness of specific types of claims data in evaluating the outcomes of care, the relative advantages of disease specific versus generic measures of functional status and health outcome, the stability of patient preferences over time and across disease states, the generalizability of consensus statements across groups of physicians and the effectiveness of alternative community based interventions in changing physician behavior. This project represents a collaborative effort by research staff at the University of Pennsylvania and practicing physicians and professional societies in eastern Pennsylvania. Three cities in eastern Pennsylvania will serve as intensive intervention sites; one city will serve as a control site. The remainder of eastern Pennsylvania will receive a less intensive intervention. Western Pennsylvania will not receive any intervention and will serve as a control. The project will have 7 stages: (1) synthesis of existing medical literature and information; (2) analysis of existing claims data; (3) collection of primary data on outcomes of care and on physician and patient preferences; (4) development of a normative model of optimal management strategies; (5) development of practice guidelines; (6) development of interventions to encourage use of these guidelines; and (7) use of primary and claims data measure the impact of the interventions on utilization and outcomes.